Utilizing Promotoras to Extend Mental Health Services to Latina Immigrants

Latino/a immigrants are at high-risk for psychological distress due in part to lower socioeconomic status, discrimination, and stressors associated with migration and residency status. Reports indicate < 5% of Latino immigrants with a mental health disorder receive care and < 30% return after their first visit. Community health workers in Spanish-speaking cultures, also known as promotoras, have helped to bridge underserved communities to the available health services offered to the community. This pilot study measured the effectiveness of employing a promotora model in the delivery of mental health services to a predominantly immigrant community. Investigators evaluated a pilot program, examining whether those assigned to promotoras experience improved scores in depression and anxiety (CES-D and GAD) compared to the therapist group. Differing treatment and engagement strategies were also evaluated.  

Using a mixed-methods design, researchers retrospectively analyzed a sample of 100 closed cases non-randomly assigned either to promotoras (n = 50) or therapists (n = 50). All clients completed pre/post treatment assessments for depression (CES-D) and anxiety (GAD) and attended ≤ 12 sessions. Participants were female (82%) and Hispanic (84%), and similar except for age (p<.01). Therapy group participants were 14 years younger than promotora participants, M= 28, SD= 13.14, and M= 42, SD= 12.58. Finally, two focus groups were conducted with promotoras (n=4) and therapists (n=6) to expand on quantitative findings, further exploring practice and engagement strategies. A qualitative descriptive analysis was utilized to determine common themes.

A repeated measures ANOVA with age as a covariate was conducted. Results demonstrated a significant improvement in scores for both depression (p<.001) and anxiety (p<.001) among all participants. More specifically, those in the promotora group significantly improved both their anxiety (p<.001) and depression (p<.001) scores. Results also demonstrated greater improvement in depression scores for the therapy group, p<.05. In contrast, no difference was found in the improvement of anxiety scores, p>.05.

Notable focus group findings revealed therapists were preoccupied with treatment fidelity and felt bound to required treatment plans and protocols. With a maximum of twelve 45-minute sessions, therapists exclusively focused on quick and efficient stabilization techniques. Therapists reported that this approach occasionally resulted in loss of client engagement. Conversely, promotoras had no time limit to their sessions and no maximum number of sessions. The combination of treatment philosophy and relaxed protocols may have afforded them the opportunity to utilize cultural grounded techniques and thereby “walking the journey” with clients, sharing and listening as peers, as well as using story and life experiences to guide intervention.

Findings support the possibility of the promotora model as a complimentary or alternative treatment option in reducing symptoms of depression and anxiety among Latina immigrants. Improvement in symptoms of anxiety may be comparable to that of therapists. The promotora model is uniquely poised to incorporate a new treatment paradigm that when integrated with existing services, may result in a more culturally-grounded model that increases service capacity and engagement. However, further testing is warranted before defining this model as an efficacious culturally grounded strategy suitable for mental health services.